BILL NUMBER: AB 1748	CHAPTERED  09/24/00

	CHAPTER   593
	FILED WITH SECRETARY OF STATE   SEPTEMBER 24, 2000
	APPROVED BY GOVERNOR   SEPTEMBER 22, 2000
	PASSED THE ASSEMBLY   AUGUST 31, 2000
	PASSED THE SENATE   AUGUST 30, 2000
	AMENDED IN SENATE   AUGUST 25, 2000
	AMENDED IN SENATE   AUGUST 7, 2000
	AMENDED IN SENATE   JUNE 14, 2000
	AMENDED IN ASSEMBLY   APRIL 27, 2000
	AMENDED IN ASSEMBLY   MARCH 29, 2000

INTRODUCED BY   Assembly Member Zettel
   (Coauthor:  Assembly Members Cunneen and Robert Pacheco)
   (Coauthor:  Senator Rainey)

                        JANUARY 12, 2000

   An act to amend Section 120440 of the Health and Safety Code,
relating to disease prevention and control.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 1748, Zettel.  Immunizations:  disclosure of information.
   Existing law governing communicable disease prevention and
immunization authorizes local health officers to operate immunization
information systems.  Existing law provides that certain health care
providers, as defined, local health departments operating countywide
immunization information and reminder systems, and the State
Department of Health Services may disclose or share certain
prescribed immunization-related information concerning individual
patients, unless the patient refuses to consent to the sharing of
this information.  Existing law authorizes disclosure of patient
information under specific circumstances, and also requires the
health care provider administering the immunization to provide the
patient with designated notice.
   This bill would authorize local health officers and the state
department to contract with an outside agency to perform immunization
information system functions.  The bill would revise the conditions
under which immunization information may be disclosed, including
authorizing local health officers and the state department to
disclose specified information to county welfare departments, as
defined.  The bill would also apply certain provisions identifying
the types of information subject to disclosure, and authorizing
refusal of permission for recordsharing, to clients of county welfare
departments, and their parents or guardians, where appropriate.
   This bill would incorporate amendments to Section 120440 of the
Health and Safety Code made by AB 2013, which would become operative
only if both bills are chaptered and this bill is chaptered after AB
2013.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:


  SECTION 1.  Section 120440 of the Health and Safety Code is amended
to read:
   120440.  (a) For the purposes of this chapter, the following
definitions shall apply:
   (1) "Health care provider" means any person licensed pursuant to
Division 2 (commencing with Section 500) of the Business and
Professions Code or a clinic or health facility licensed pursuant to
Division 2 (commencing with Section 1200).
   (2) "Schools, child care facilities, and family child care homes"
means those institutions referred to in subdivision (b) of Section
120335, regardless of whether they directly provide immunizations to
patients or clients.
   (3) "WIC service provider" means any public or private nonprofit
agency contracting with the department to provide services under the
California Special Supplemental Food Program for Women, Infants, and
Children, as provided for in Article 2 (commencing with Section
123275) of Chapter 1 of Part 2 of Division 106.
   (4) "Health care plan" means a health care service plan as defined
in subdivision (f) of Section 1345 or an insurer as described in
Sections 10123.5 and 10123.55 of the Insurance Code, regardless of
whether the plan directly provides immunizations to patients or
clients.
   (5) "County welfare department" means a county welfare agency
administering the California Work Opportunity and Responsibility to
Kids (CalWORKs) program, pursuant to Chapter 2 (commencing with
Section 11200.5) of Part 3 of Division 9 of the Welfare and
Institutions Code.
   (b) (1) Local health officers may operate immunization information
systems pursuant to their authority under Section 120175, in
conjunction with the Immunization Branch of the State Department of
Health Services.  Local health officers and the State Department of
Health Services may operate these systems in either or both of the
following manners:
   (A) Separately within their individual jurisdictions.
   (B) Jointly among more than one jurisdiction.
   (2) Nothing in this subdivision shall preclude local health
officers from sharing the information set forth in paragraphs (1) to
(9), inclusive, of subdivision (c) with other health officers jointly
operating the system.
   (c) Notwithstanding Sections 49075 and 49076 of the Education
Code, Chapter 6 (commencing with Section 10850), or any other
provision of law, unless a refusal to permit recordsharing is made
pursuant to subdivision (e), health care providers, and other
agencies, including, but not limited to, schools, child care
facilities, service providers for the California Special Supplemental
Food Program for Women, Infants, and Children (WIC), health care
plans, and county welfare departments, may disclose the information
set forth in paragraphs (1) to (9), inclusive, from the patient's
medical record, or the client's record, to local health departments
operating countywide immunization information and reminder systems
and the State Department of Health Services.  Local health
departments and the State Department of Health Services may disclose
the information set forth in paragraphs (1) to (9), inclusive, to
each other, and upon a request for information pertaining to a
specific person, to health care providers taking care of the patient.
  Local health departments and the State Department of Health
Services may disclose the information in paragraphs (1) to (6),
inclusive, and paragraphs (8) and (9), to schools, child care
facilities, county welfare departments, and family child care homes
to which the person is being admitted or in attendance, and WIC
service providers providing services to the person, health care plans
arranging for immunization services for the patient, and county
welfare departments assessing immunization histories of dependents of
CalWORKs participants, upon request for information pertaining to a
specific person.  Determination of benefits based upon immunization
of a dependent CalWORKs participant shall be made pursuant to Section
11265.8 of the Welfare and Institutions Code.  The following
information shall be subject to this subdivision:
   (1) The name of the patient or client and names of the parents or
guardians of the patient or client.
   (2) Date of birth of the patient or client.
   (3) Types and dates of immunizations received by the patient or
client.
   (4) Manufacturer and lot number for each immunization received.
   (5) Adverse reaction to immunizations received.
   (6) Other nonmedical information necessary to establish the
patient's or client's unique identity and record.
   (7) Current address and telephone number of the patient or client
and the parents or guardians of the patient or client.
   (8) Patient's or client's gender.
   (9) Patient's or client's place of birth.
   (d) (1) Health care providers, local health departments, and the
State Department of Health Services shall maintain the
confidentiality of information listed in subdivision (c) in the same
manner as other medical record information with patient
identification that they possess.  These providers, departments, and
contracting agencies are subject to civil action and criminal
penalties for the wrongful disclosure of the information listed in
subdivision (c), in accordance with existing law.  They shall use the
information listed in subdivision (c) only for the following
purposes:
   (A) To provide immunization services to the patient or client,
including issuing reminder notifications to patients or clients or
their parents or guardians when immunizations are due.
   (B) To provide or facilitate provision of third-party payer
payments for immunizations.
   (C) To compile and disseminate statistical information of
immunization status on groups of patients or clients or populations
in California, without identifying information for these patients or
clients included in these groups or populations.
   (D) In the case of health care providers only, as authorized by
Part 2.6 (commencing with Section 56) of Division 1 of the Civil
Code.
   (2) Schools, child care facilities, family child care homes, WIC
service providers, county welfare departments, and health care plans
shall maintain the confidentiality of information listed in
subdivision (c) in the same manner as other client, patient, and
pupil information that they possess.  These institutions and
providers are subject to civil action and criminal penalties for the
wrongful disclosure of the information listed in subdivision (c), in
accordance with existing law.  They shall use the information listed
in subdivision (c) only for those purposes provided in subparagraphs
(A) to (D), inclusive, of paragraph (1) and as follows:
   (A) In the case of schools, child care facilities, family child
care homes, and county welfare departments, to carry out their
responsibilities regarding required immunization for attendance or
participation benefits, or both, as described in Chapter 1
(commencing with Section 120325), and in Section 11265.8 of the
Welfare and Institutions Code.
   (B) In the case of WIC service providers, to perform immunization
status assessments of clients and to refer those clients found to be
due or overdue for immunizations to health care providers.
   (C) In the case of health care plans, to facilitate payments to
health care providers, to assess the immunization status of their
clients, and to tabulate statistical information on the immunization
status of groups of patients, without including patient-identifying
information in these tabulations.
   (e) A patient or a patient's parent or guardian may refuse to
permit recordsharing.  The health care provider administering
immunization and any other agency possessing any patient or client
information listed in subdivision (c), if planning to provide patient
or client information to an immunization system, as described in
subdivision (b), shall inform the patient or client, or the parent or
guardian of the patient or client, of the following:
   (1) The information listed in subdivision (c) may be shared with
local health departments, and the State Department of Health
Services.  The health care provider or other agency shall provide the
name and address of the department or departments with which the
provider or other agency will share the information.
   (2) Any of the information shared with local health departments
and the State Department of Health Services shall be treated as
confidential medical information and shall be used only to share with
each other, and, upon request, with health care providers, schools,
child care facilities, family child care homes, WIC service
providers, county welfare departments, and health care plans.  These
providers, agencies, and institutions shall, in turn, treat the
shared information as confidential, and shall use it only as
described in subdivision (d).
   (3) The patient or client, or parent or guardian of the patient or
client, has the right to examine any immunization-related
information shared in this manner and to correct any errors in it.
   (4) The patient or client, or the parent or guardian of the
patient or client, may refuse to allow this information to be shared
in the manner described, or to receive immunization reminder
notifications at any time, or both.
   (f) If the patient or client, or parent or guardian of the patient
or client, refuses to allow the information to be shared, pursuant
to paragraph (4) of subdivision (e), the health care provider or
other agency may not share this information in the manner described
in subdivision (c), except as provided in subparagraph (D) of
paragraph (1) of subdivision (d).
   (g) Upon request of the patient or client, or the parent or
guardian of the patient or client, in writing or by other means
acceptable to the recipient, a local health department or the State
Department of Health Services that has received information about a
person pursuant to subdivision (c) shall do all of the following:
   (1) Provide the name and address of other persons or agencies with
whom the recipient has shared the information.
   (2) Stop sharing the information in its possession after the date
of the receipt of the request.
   (h) Upon notification, in writing or by other means acceptable to
the recipient, of an error in the information, a local health
department or the State Department of Health Services that has
information about a person pursuant to subdivision (c) shall correct
the error.  If the recipient is aware of a disagreement about whether
an error exists, information to that effect may be included.
   (i) Section 120330 shall not apply to this section.
  SEC. 2.  Section 120440 of the Health and Safety Code is amended to
read:
   120440.  (a) For the purposes of this chapter, the following
definitions shall apply:
   (1) "Health care provider" means any person licensed pursuant to
Division 2 (commencing with Section 500) of the Business and
Professions Code or a clinic or health facility licensed pursuant to
Division 2 (commencing with Section 1200).
   (2) "Schools, child care facilities, and family child care homes"
means those institutions referred to in subdivision (b) of Section
120335, regardless of whether they directly provide immunizations to
patients or clients.
   (3) "WIC service provider" means any public or private nonprofit
agency contracting with the department to provide services under the
California Special Supplemental Food Program for Women, Infants, and
Children, as provided for in Article 2 (commencing with Section
123275) of Chapter 1 of Part 2 of Division 106.
   (4) "Health care plan" means a health care service plan as defined
in subdivision (f) of Section 1345 or an insurer as described in
Sections 10123.5 and 10123.55 of the Insurance Code, regardless of
whether the plan directly provides immunizations to patients or
clients.
   (5) "Local registry" means an immunization information system
operated by a city or county health department.
   (6) "Regional registry" means an immunization information system
operated on a multicounty or multicity health department basis.
   (7) "County welfare department" means a county welfare agency
administering the California Work Opportunity and Responsibility to
Kids (CalWORKs) program, pursuant to Chapter 2 (commencing with
Section 11200) of Part 3 of Division 9 of the Welfare and
Institutions Code.
   (b) (1) Local health departments may operate local or regional
registries pursuant to their authority under Section 120175, in
conjunction with the Immunization Branch of the State Department of
Health Services.
   (2) Health care providers providing immunizations to persons 18
years of age and younger shall be required to participate in a local
or regional registry, either directly or through the Statewide
Immunization Information System, when the department has certified
that the local or regional registry is functional and able to
accommodate participation by all providers in the registry's service
area.  Department certification shall include, but shall not be
limited to, consultation with health care providers and the ability
of the registry to provide technical support.  Local or regional
registries may not charge health care providers for any training that
is necessary for the health care registry provider to participate in
the registry.  However, with respect to information concerning a
specific patient or client, information shall not be included in the
local or regional registry if consent has been withheld by the
patient or client, or, in the case of a patient or client under 18
years of age who is not legally emancipated, by the patient's or
client's parent or legal guardian.
   (3) Nothing in this section shall preclude local health officers
from sharing the information set forth in paragraphs (1) to (9),
inclusive, of subdivision (c) with other health officers jointly
operating the system.
   (c) Notwithstanding Sections 49075 and 49076 of the Education
Code, Chapter 6 (commencing with Section 10850), or any other
provision of law, unless a refusal to permit recordsharing is made
pursuant to subdivision (e), health care providers, and other
agencies, including, but not limited to, schools, child care
facilities, service providers for the California Special Supplemental
Food Program for Women, Infants, and Children (WIC), health care
plans, and county welfare departments, may disclose the information
set forth in paragraphs (1) to (9), inclusive, from the patient's
medical record or the client's record, to local health departments
operating  local or regional registries and the State Department of
Health Services.  Local health departments and the State Department
of Health Services may disclose the information set forth in
paragraphs (1) to (9), inclusive, to each other, and upon a request
for information pertaining to a specific person, to health care
providers taking care of the patient.  Local health departments and
the State Department of Health Services may disclose the information
in paragraphs (1) to (6), inclusive, and paragraphs (8) and (9), to
schools, child care facilities, county welfare departments, and
family child care homes to which the person is being admitted or in
attendance, and WIC service providers providing services to the
person, health care plans arranging for immunization services for the
patient, and county welfare departments assessing immunization
histories of dependents of CalWORKs participants, upon request for
information pertaining to a specific person.  Determination of
benefits based upon immunization of a dependent CalWORKs participant
shall be made pursuant to Section 11265.8 of the Welfare and
Institutions Code.  The following information shall be subject to
this subdivision:
   (1) The name of the patient or client and names of the patient's
parents or guardians of the patient or client.
   (2) Date of birth of the patient or client.
   (3) Types and dates of immunizations received by the patient or
client.
   (4) Manufacturer and lot number for each immunization received.
   (5) Adverse reaction to immunizations received.
   (6) Other nonmedical information necessary to establish the
patient's or client's unique identity and record.
   (7) Current address and telephone number of the patient or client
and the parents or guardians of the patient or client.
   (8) Patient's or client's gender.
   (9) Patient's or client's place of birth.
   (d) (1) Health care providers, local health departments, and the
State Department of Health Services shall maintain the
confidentiality of information listed in subdivision (c) and any
information contained in a local or regional registry or in the
Statewide Immunization Information System in the same manner as other
medical record information with patient identification that they
possess.  These providers, departments and contracting agencies shall
be subject to civil action and criminal penalties for the wrongful
disclosure of the information listed in subdivision (c), in
accordance with existing law.  They shall use the information listed
in subdivision (c) only for the following purposes:
   (A) To provide immunization services to the patient or client,
including issuing reminder notifications to patients or clients or
their parents or guardians when immunizations are due.
   (B) To provide or facilitate provision of third-party payer
payments for immunizations.
   (C) To compile and disseminate statistical information of
immunization status on groups of patients or clients or populations
in California, without identifying information for these patients or
clients included in these groups or populations.
   (D) In the case of health care providers only, as authorized by
Part 2.6 (commencing with Section 56) of Division 1 of the Civil
Code.
   (2) Schools, child care facilities, family child care homes, WIC
service providers, and county welfare departments, and health care
plans shall maintain the confidentiality of information listed in
subdivision (c) in the same manner as other client, patient, and
pupil information that they possess.  These institutions and
providers are subject to civil action and criminal penalties for the
wrongful disclosure of the information listed in subdivision (c), in
accordance with existing law.  They shall use the information listed
in subdivision (c) only for those purposes provided in subparagraphs
(A) to (D), inclusive, of paragraph (1) and as follows:
   (A) In the case of schools, child care facilities, and family
child care homes, and county welfare departments, to carry out their
responsibilities regarding required immunization for attendance, or
participation benefits, or both, as described in Chapter 1
(commencing with Section 120325) and in Section 11265.8 of the
Welfare and Institutions Code.
   (B) In the case of WIC service providers, to perform immunization
status assessments of clients and to refer those clients found to be
due or overdue for immunizations to health care providers.
   (C) In the case of health care plans, to facilitate payments to
health care providers, to assess the immunization status of their
clients, and to tabulate statistical information on the immunization
status of groups of patients, without including patient-identifying
information in these tabulations.
   (e) A patient or a patient's parent or guardian may refuse to
permit recordsharing.  The health care provider administering
immunization and any other agency possessing any patient or client
information listed in subdivision (c), if planning to provide patient
or client information to an immunization system, as described in
subdivision (b), shall inform the patient or clients, or the parent
or guardian of the patient or client of the following:
   (1) The information listed in subdivision (c) may be shared with
local health departments, and the State Department of Health
Services.  The health care provider or other agency shall provide the
name and address of the department or departments with which the
provider or other agency will share the information.
   (2) Any of the information shared with local health departments
and the State Department of Health Services shall be treated as
confidential medical information and shall be used only to share with
each other, and, upon request, with health care providers, schools,
child care facilities, family child care homes, WIC service
providers, county welfare departments, and health care plans.  These
providers, agencies, and institutions shall, in turn, treat the
shared information as confidential, and shall use it only as
described in subdivision (d).
   (3) The patient or client, or parent or guardian of the patient or
client, has the right to examine any immunization-related
information shared in this manner and to correct any errors in it.
   (4) The patient or the client, or parent or guardian of the
patient or client, may refuse to allow this information to be shared
in the manner described, or to receive immunization reminder
notifications at any time, or both.
   (f) If the patient or client, or parent or guardian of the patient
or client, refuses to allow the information to be shared, pursuant
to paragraph (4) of subdivision (e), the health care provider or
other agency may not share this information in the manner described
in subdivision (c), except as provided in subparagraph (D) of
paragraph (1) of subdivision (d).
   (g) Upon request of the patient or the client, or the parent or
guardian, of the patient or client in writing or by other means
acceptable to the recipient, a local health department or the State
Department of Health Services that has received information about a
person pursuant to subdivision (c) shall do all of the following:
   (1) Provide the name and address of other persons or agencies with
whom the recipient has shared the information.
   (2) Stop sharing the information in its possession after the date
of the receipt of the request.
   (h) Upon notification, in writing or by other means acceptable to
the recipient, of an error in the information, a local health
department or the State Department of Health Services that has
information about a person pursuant to subdivision (c) shall correct
the error.  If the recipient is aware of a disagreement about whether
an error exists, information to that effect may be included.
   (i) Section 120330 shall not apply to this section.
  SEC. 3.  Section 2 of this bill incorporates amendments to Section
120440 of the Health and Safety Code proposed by both this bill and
AB 2013.  It shall only become operative if (1) both bills are
enacted and become effective on or before January 1, 2001, (2) each
bill amends Section 120440 of the Health and Safety Code, and (3)
this bill is enacted after AB 2013, in which case Section 1 of this
bill shall not become operative.
